Your Prescription Drug Benefit Handbook

Transcription

1 Your Prescription Drug Benefit Handbook

2 Welcome! We're proud that your health plan has chosen Medco to manage your prescription drug benefit for retail and mail-order services. You're now with the industry leader. Medco has provided quality prescription drug benefit services to millions of Americans for over 30 years. What's inside: Your prescription drug benefit at a glance...3 Medications preferred by your plan...3 Your pharmacy options...4 Online services...6 General information...7 Other things you should know...8

3 Your prescription drug benefit at a glance Your plan gives you the option of getting your covered prescriptions through mail order or a participating retail pharmacy. For your short-term prescription needs, you may visit a participating retail pharmacy. When you present your prescription drug ID card, you will be charged a co-payment for your prescription. For medication you take on an ongoing basis, using Medco By Mail offers you convenience and potential cost savings. Your official plan document contains more specific information about your pharmacy coverage. Note: This information is an overview of your health plan prescription drug benefit. Benefits and co-payments are subject to change by your health plan. Medications preferred by your plan Your plan includes a list of prescription drugs that are preferred by your plan because they help to control rising costs. This list, sometimes called a formulary, offers a wide selection of generic and brand-name medications. Show the enclosed list to your doctor so you can discuss whether a drug on the list is right for you. If you need information about it now, visit us at or call us toll-free at Member Services. 3

4 Your pharmacy options Retail pharmacies You may want to use a participating retail pharmacy for short-term prescriptions (such as antibiotics to treat infections). Be sure to show your prescription drug ID card to the pharmacist. You'll pay your retail payment for each prescription. To find a participating retail pharmacy near you: Visit and click "Locate a pharmacy." Ask at your retail pharmacy whether it participates in the Medco network. If you use a nonparticipating retail pharmacy, you must pay the entire cost of the prescription and then submit a reimbursement claim to Medco. Plans that allow members to use nonparticipating retail pharmacies generally reimburse the amount the drug would have cost at a participating retail pharmacy, minus your retail payment. If you use a nonparticipating pharmacy, your plan may not reimburse the cost of your prescriptions. You can call Member Services to find out whether your plan reimburses for costs incurred at a nonparticipating pharmacy. Medco By Mail pharmacies Over 6 million members enjoy the convenience and savings of having their long-term medications (those taken for 3 months or more) delivered to their home or office. Medications are dispensed by Medco By Mail pharmacists through our network of mail-order pharmacies. Medco By Mail advantages: Get up to a 3-month supply (typically 90 days) compared with a 1-month supply (typically 30 days) at retail of each covered medication for just one mail-order co-payment. Registered pharmacists are available 24 hours a day, 7 days a week. Order refills online, by mail, or by phone anytime day or night. To order online, register at Refills are usually delivered within 3 to 5 days after we receive your order. 4

5 Choose a convenient payment option Medco offers a safe, convenient method of paying for prescription orders. E-check is an electronic funds transfer system that automatically deducts payments from your checking account. You can also pay by money order, personal check, credit card, or through our automatic payment program. For more information, visit or call Member Services. Standard shipping is free. To determine the amount of your order, price your medications online at or call Member Services. You can elect to have your credit card automatically charged by enrolling in Medco's automatic payment program. Please note: Payment should be included at the time your order is placed. If you do not include payment with your order and the amount you owe exceeds the set amount determined by your plan, we will not be able to process your order. How to start saving with Medco By Mail 1 When using Medco By Mail, be sure to ask your doctor to write a prescription for an extended supply, typically 3 months or 90 days, of each medication (plus refills for up to 1 year, if appropriate). A prescription for a 1-month (30-day) supply with refills cannot be combined to equal a 3-month (90-day) supply. 2 Fill out the enclosed Medco By Mail order form. 3 Send the completed form, your prescription, and your payment in the Medco By Mail envelope provided. Your medication will usually be delivered within 8 days after we receive your order. If you are currently taking a medication, be sure to have at least a 14-day supply on hand when ordering. If you don't have enough, ask your doctor to give you a 14-day prescription to fill at a participating retail pharmacy while your mail-order prescription is being processed. 5

6 You may also have your doctor fax your prescriptions. Ask your doctor to call for faxing instructions. Specialty care pharmacy Complex conditions, such as anemia, hepatitis C, multiple sclerosis, asthma, growth hormone deficiency, and rheumatoid arthritis, are treated with specialty medications. Specialty medications are typically injectable medications administered either by you or a healthcare professional, and they often require special handling. If you use specialty medications, you'll appreciate the extras offered by Medco's specialty care pharmacy, Accredo Health Group, including: Answers to your questions or concerns about your specialty medications from a pharmacist 24 hours a day, 7 days a week Personalized counseling from our dedicated team of registered nurses and pharmacists Coordination of home care and other healthcare services, when appropriate, if in-home nursing assistance is covered by your plan Expedited, scheduled delivery of your medications at no extra charge Up to a 90-day supply of your specialty medication for just one payment For more information, please call Member Services. Online services If you have Internet access, you can take advantage of Medco's awardwinning, consumer-friendly website. More than 4 million active registered users visit to: Compare the cost of brand-name and generic drugs at retail and via mail order. Access plan highlights, as well as health and wellness information. Obtain order forms, claim forms, and envelopes. Submit mail-order refills. Check the status of Medco By Mail orders. 6

7 General information To contact Member Services Member Services is available 24 hours a day, 7 days a week (except Thanksgiving and Christmas) by calling the toll-free number located on the back of your prescription drug ID card. Our Member Services representatives can: Help you find a participating retail pharmacy Send you order forms, claim forms, and envelopes Answer questions about your prescriptions or plan coverage To access Medco by TTY TTY is available for hearing-impaired members. Call To order prescription labels printed in braille Braille labels are available for mail-order prescriptions. Call Member Services. 7

8 Other things you should know Medco protects your safety The risks associated with drug-to-drug interactions and drug allergies can be very serious. To protect your safety whether you use Medco By Mail or medco.com Medco checks for potential interactions and allergies. We also send information electronically to participating retail pharmacies. Medco may contact your doctor about your prescription If you are prescribed a drug that is not on your plan's preferred list, yet an alternative planpreferred drug exists, we may contact your doctor to ask whether that drug would be appropriate for you. If your doctor agrees to use a plan-preferred drug, you will never pay more and will usually pay less. Medco protects your privacy Because your privacy is important to us, Medco complies with federal privacy regulations. Medco uses health and prescription information about you and your dependents to administer your plan and to fill your mail-order prescriptions. Your plan may have coverage limits Your plan may have certain coverage limits. For example, prescription drugs used for cosmetic purposes may not be covered, or a medication might be limited to a certain amount (such as the number of pills or total dosage) within a specific time period. If you submit a prescription for a drug that has coverage limits, your pharmacist will tell you that approval is needed before the prescription can be filled. The pharmacist will give you or your doctor a toll-free number to call. If you use Medco By Mail, your doctor will be contacted directly. When a coverage limit is triggered, more information is needed to determine whether your use of the medication meets your plan's coverage conditions. We will notify you and your doctor in writing of the decision. If coverage is approved, the letter will indicate the amount of time for which coverage is valid. If coverage is denied, an explanation will be provided, along with instructions on how to submit an appeal. Controlled substances Federal law prohibits the return of dispensed controlled substances. Medco manages your prescription drug benefit for your health plan. Medco and medco.com are registered trademarks of Medco Health Solutions, Inc Medco Health Solutions, Inc. All rights reserved. 8